Hydrotherapy or Balneotherapy is a specialty area of physiotherapy and is used to help a wide demographic or person as well as a number of different musculoskeletal complaints as well as chronic pain. It usually involves very warm water, which is therapeutic in itself, and bridges the gap for those who find land based exercise difficult or near impossible to do. It takes the edge off of the pain and relieves anxiety which often creates a cycle of uncontrollable pain.

But what if we make the water cold?

In response to acute tissue damage/injury, feelings of fear are heightened as part of a normal consequence of pain. The individual will rest and protect the painful area as an adaptive behaviour to allow tissue healing to occur. As the acute phase and initial tissue healing resolves, it has been suggested that some individuals can confront their fearful emotions and are able to resume normal activities, which ultimately extinguish their fears as they experience positive increase in mobility/movement not associated with further increase in pain. For others, they may be unable to overcome the fearful emotion and the resulting avoidance behaviour persists. A cycle of continued activity avoidance and fearful emotions may ensue, the longstanding effect of which in patients with chronic pain may have an adverse effect on the musculoskeletal and cardiovascular system (disuse syndrome), which fundamentally increases disability. Several models have been proposed to explain the persistence of ‘fear-avoidance’ and its impact on pain and behaviour.

Cold water therapy, although it may not sound pleasant, may well be a new approach to managing this sort of catastrophizing pain behavior and aid in breaking the downward spiral and facilitate recovery with exercise. It is said to work by increasing your body’s ability to cope with stress and pain but making your coping system more robust. The theory makes sense and evidence shows it may well work.

In brief it is hypothesized to work by activating the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect.